Provider Demographics
NPI:1629512900
Name:KENNEDY, DANIEL (MOTR/L)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 NE SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-5019
Mailing Address - Country:US
Mailing Address - Phone:785-383-3018
Mailing Address - Fax:
Practice Address - Street 1:8559 N LINE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2100
Practice Address - Country:US
Practice Address - Phone:816-468-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1702908225X00000X
MO2010022884225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist